Provider Demographics
NPI:1164812582
Name:SENIOR CARE PHYSICIANS
Entity Type:Organization
Organization Name:SENIOR CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-431-0039
Mailing Address - Street 1:29122 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2606
Mailing Address - Country:US
Mailing Address - Phone:313-506-1776
Mailing Address - Fax:
Practice Address - Street 1:4241 MAPLE ST
Practice Address - Street 2:SUITE 200C
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3826
Practice Address - Country:US
Practice Address - Phone:313-506-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105543208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty